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Background: Pharmaceutical care (PC) services play a crucial role in optimizing patients' drug therapy and improving treatment outcomes. This study aimed to assess community pharmacists' awareness, attitude, and practice toward PC in eastern Nepal.
Methods: A prospective cross-sectional study was conducted among registered pharmacists practicing community pharmacy in the Morang district, eastern Nepal, from February 2023 to July 2023. A self-administered 24-item structured questionnaire was used to assess participants' knowledge, attitude, and practice (KAP) toward PC. The participants' KAP was classified into good (>80%), moderate (60-79%), and poor (<60%) levels, respectively, using Bloom's cut-off score points. The chi-square test and Spearman's correlation test were employed to assess the association between the dependent and independent variables.
Results: A total of 193 community pharmacists participated in this study; among them, most were male (73.1%) and under 30 years old (58.5%). Most participants (90.7%) had certificate-level pharmacy qualifications. The majority of the community pharmacists possessed good knowledge (65.3%) and attitude (47.7%) toward PC; however, their practice of PC services was poor (51.3%). The participants' age group and qualifications were significantly linked to a good understanding of PC, while gender was associated with better PC practices (p < 0.05).
Conclusion: The study revealed that nearly two-thirds of the community pharmacists had adequate knowledge about PC, but their attitude and practice toward PC were suboptimal. Strict regulatory enforcement of PC-centered pharmacy practice, as well as PC practice-dedicated educational and interventional programs, are recommended for community pharmacy practitioners in this area.

Backgrounds: Globally, colorectal cancer ranks as the second cause of mortality and the third most diagnosed cancer. Curcumin has been investigated as an adjunct therapy in various cancers, mostly in pre-clinical studies, particularly by acting as a chemo-sensitizer.
Objectives: The present study aimed to evaluate the effectiveness of oral formulation of nano-curcumin as an adjuvant treatment in patients with metastatic colorectal cancer receiving the XELOX/FOLFOX±Bevacizumab regimen.
Methods: In this study, 94 patients with metastatic colorectal cancer who completed the inclusion and exclusion criteria were randomized into the nano-curcumin and placebo groups. 40 mg nano-curcumin capsules were administered three times a day after each meal, beginning the first day to the end of the sixth cycle of chemotherapy. Carcinoembryonic antigen (CEA) level and radiological response based on Response Evaluation Criteria in Solid Tumors (RECIST version 1.1) were evaluated. The data were analyzed using SPSS version 13.
Results: All baseline demographic, clinical, and laboratory variables were comparable between placebo and nano-curcumin groups. The administration of nano-curcumin showed no significant impact on carcinoembryonic antigen (CEA) levels. There was also no significant difference in both arms regarding RECIST criteria at the end of the 3rd and 6th cycle.
Conclusion: Our findings suggest that nano-curcumin with the prescribed dose did not show considerable efficacy in the radiologic response of metastatic colorectal cancer based on RECIST criteria. The CEA serum level also did not change significantly in comparison with the placebo. Further research is needed to assess various nano-curcumin formulations, dosing, and timing for initiating curcumin for better judgment.

Background: This study aimed to evaluate physicians' practice regarding perioperative Direct Oral Anticoagulants (DOACs) management in patients undergoing elective procedures and compare it to established institutional standard protocols and the most recent guidelines.
Methods: Over seven months, a cross-sectional descriptive-analytical study was conducted at Imam Khomeini Hospital Complex, affiliated with Tehran University of Medical Sciences. Patients receiving DOACs and undergoing elective procedures/surgery were enrolled.
Results: In total, 170 patients who underwent 200 procedures while taking DOACs were included, with a total mean age (SD) of 62.2 (16.5) years. DOAC therapy was primarily prescribed for atrial fibrillation (75%) and deep vein thrombosis (25%), with 97% taking Apixaban. Approximately 125 (62.5%) of the performed procedures were categorized as high risk for bleeding, among which only 16.8% adhered to preoperative management guidelines. The mean (SD) time to reintroduce DOACs after procedures was 57.7 (45.3) hours. Bridge therapy was used in 66% of cases before and 74% after procedures. Blood products were administered in 36 cases of high-risk procedures. The average overall perioperative management score calculated was 3.3, representing less than 50% of the maximum possible score of 7. In only 8.5% (N=17) of the procedures, the total pre- and postoperative management of DOACs was concordant with the guideline.
Conclusion: The study showed poor perioperative adherence to international DOAC management guidelines. Expert collaboration is crucial for DOAC patients undergoing surgery. More research is needed to understand the reasons for low adherence.

Background: One of the essential responsibilities of pharmacists is to provide information and advice regarding over-the-counter (OTC) medications. This study investigates the knowledge, attitudes, and practices (KAP) of community pharmacists in Karaj, Iran, concerning OTC medications.
Method: Data collection was conducted using a researcher-made questionnaire. The questionnaire comprises four sections: Demographic information (13 questions), and questions on knowledge (6 questions), attitudes (7 questions), and practices (3 questions) of community pharmacists in providing pharmaceutical consulting services for OTC medications.
Results: Among the 116 pharmacists who participated in this study, 59.5% were women and 40.5% were men (mean age = 41.4 years). The levels of knowledge and practice among the participants were suboptimal, as only 21 pharmacists (18.1%) achieved satisfactory scores in knowledge, and only 9 pharmacists (7.8%) demonstrated satisfactory practices. Additionally, 71 pharmacists (61.2%) received moderate scores in attitudes. A significant correlation was found between the level of knowledge and participation in training courses on OTC medications. The results also demonstrated that younger pharmacists exhibited better knowledge.
Conclusion: The results revealed that only a small proportion of pharmacists demonstrated satisfactory knowledge and performance regarding OTC medications. Additionally, the present study highlighted a decline in pharmacists' knowledge levels as they transitioned away from the academic environment, underscoring the necessity for improved post-graduate training programs.

Background: Biotherapeutics are a class of therapeutic products derived from biological sources and used in the treatment of different diseases and disorders. Data on biotherapeutic utilization in different diseases is inadequate in the pediatric population.
Methods: This observational, cross-sectional study was conducted for a year to audit the use of biotherapeutics in Pediatric patients (1-12 yrs) at a tertiary care hospital. The data on biotherapeutics was collected in Case Report Forms (CRFs) validated by peers and subject experts. The adverse reaction of biotherapeutics was recorded in the Suspected Adverse Drug Reaction Form (version 1.4). The price of biotherapeutics was calculated as the average price of a standard manufacturer available at the hospital.
Results: A total of 141 patients were recruited and it was found that intravenous immunoglobulin (IVIG) (35.46%), 20% human albumin (25.53%), recombinant human growth hormone (17.02%), filgrastim (7.80%), rituximab (6.38%), Tocilizumab (1.41%), factor VIII (2.12%), diphtheria antitoxin (0.70%), erythropoietin (0.70%), infliximab (0.70%), factor VIIa (0.07%), insulin and insulin with glargine (0.07%) and streptokinase (0.07%) were used in treatment of various diseases and disorders. About one-third of patients (35%) received biotherapeutics as a 1^st line of treatment, and 90% experienced no adverse effects. Regardless of biotherapeutic use, we observed headache, fever, respiratory distress, and ankle swelling as adverse effects. The annual biotherapeutics budget was INR 6,786,137, with intravenous immunoglobulin (IVIG) accounting for the main expenditures at INR 5,720,000.
Conclusion:  In developing countries, technological advancements and increased availability of biotherapeutics and the use of biosimilars may reduce costs in the future. This study will also help in the formulation of budgets for tertiary care hospitals.

Cerebrovascular diseases, including ischemic and hemorrhagic strokes, rank among the leading causes of worldwide mortality and long-term morbidity. An acute systemic inflammatory reaction is one of the primary acute-phase responses that occur following the onset of a stroke. Elevated expression of inflammatory markers such as cytokines can be observed early after a stroke's onset and may negatively influence the outcome. Interleukin-6 (IL-6) is considered a pleiotropic cytokine with both pro-inflammatory and anti-inflammatory effects and plays a crucial role in the inflammatory cascade following a stroke. IL-6 is essential for regulating the immune response. However, during the acute phase of a stroke, its overproduction can promote inflammation by acting as a proinflammatory cytokine, potentially exacerbating both the disease progression and the inflammatory response. Despite numerous investigations, the exact role and mechanism of action of IL-6 after a stroke remain complex and have yet to be fully explained. The present narrative review aims to assess serum and cerebrospinal fluid changes in IL-6 during different phases of the disease in both ischemic and hemorrhagic strokes and their possible correlation with short-term and long-term functional and neurological outcomes. We explore the potential application of IL-6 as a prognostic factor for diagnosis, recognition of subtypes, assessment of stroke severity, and prediction of outcomes. In this narrative review, peer-reviewed journal articles from 1990 to 2022 were searched on PubMed, MEDLINE, ScienceDirect, and Google Scholar to identify original studies. Several relevant articles were then selected based on their comprehensiveness and informativeness. Results suggest that IL-6 levels peak during the acute phase of both ischemic and hemorrhagic strokes, with elevated concentrations correlating with worse clinical outcomes, including poorer functional recovery and an increased risk of complications. The findings underscore the potential value of IL-6 as a biomarker for early prognostication and guiding clinical decision-making. In conclusion, IL-6 shows potential as a prognostic tool and therapeutic target in stroke management. However, its exact role remains unclear, and further research is needed to better understand its mechanisms and determine the optimal timing for measurement to ensure accurate predictions.

Background: Drug-induced QTc prolongation represents the predominant cause of acquired long QTc syndrome. Pharmacists’ intervention, through the screening of at-risk patients and the provision of recommendations to prescribers for modifying drug regimens, may mitigate the adverse outcomes associated with this condition. This cross-sectional study aimed to evaluate the role of clinical pharmacists in reducing drug-induced acquired long QTc syndrome and mitigating the risk of progression toward life-threatening arrhythmias.
Methods: We included hospitalized patients who were receiving at least two concomitant QT-prolonging medications, or one QT-prolonging medication along with a diagnosis of heart failure, myocardial infarction, or sepsis in the study over three months. Using the Tisdale risk score, we provided recommendations to the prescribing physician, and acceptance rates were recorded. Additionally, the rate of QTc prolongation was assessed in the patients.
Results: The study was completed with 90 patients. The concomitant use of
ondansetron and methadone was identified as the most common high-risk drug combination. A total of 56 pharmacist recommendations were made, with an estimated physician acceptance rate of 89%. Additionally, normalization of the QTc interval was observed in 14 out of 22 patients (63.6%) following pharmacists’ intervention.
Conclusion: Clinical pharmacists are instrumental in the prevention of drug-induced long QTc syndrome among hospitalized patients.